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Registration Form
Lifeline Fall 2000 Retreat, Nov. 10-12, 2000, at Camp Berachah. "FULLY RELY ON GOD"
Print this form, fill it out, and mail it to Lifeline Retreat, PO Box 2906, Woodinville, WA 98072 with a check made out to O.C.C. for $70.00. It must arrive no later than Tues, 10/31/2000. For info, call Mike Wagner, 206-527-7978 [mikewag@bigfoot.com], or Phil Hanson, 425-444-9831 [phanson7@yahoo.com].
NAME: _____________________________________
STREET:____________________________________________________________
CITY:_____________________________ ST:_______ ZIP:________________
HOME PHONE:_______________________________ WORK PHONE:_______________________________
E-MAIL ADDRESS:_____________________________________________ GENDER: M:____ F:____
IS THIS YOUR FIRST LIFELINE RETREAT? YES:____ NO:____
Any special dietary or access needs: ___________________________________
_______________________________________________________________
_______________________________________________________________
Enclose ....(includes lodging and meals).........................................................................$70.00
Would you like to help sponsor others by making an additional contribution?
____ $17.00 (1/4 scholarship)
____ $35.00 (1/2 scholarship)
____ $70.00 (full scholarship)
____ Other, for $___________
Total amount enclosed: ...................................................................................................$_______
RELEASE: (please sign)
I, _____________________________, hereby release Overlake Christian Church, its officers, directors, and agents from any and all civil liability should any accident or injury happen to me while attending this retreat. In the event that I am unconscious or unable to communicate, I give my permission to be treated by the nearest available medical facility. I understand that I am responsible to my own accident and health insurance. OCC DOES NOT PROVIDE ACCIDENT INSURANCE for its activities.
Signature: ___________________________________________ Date:_______________
Send to: Lifeline Fall Retreat, PO Box 2906, Woodinville, WA 98072